implementing a tool to identify risk for venous thromboembolism in cancer patients

Conditions: Venous Thromboembolism; Deep-Vein Thrombosis; Pulmonary Embolism; Cancer

Summary: cancer increases the risk of deep vein blood clots and clots traveling to the lungs (emboli) which cause morbidity (leg swelling, pain, and shortness of breath), sudden death, delays cancer treatment, and decreases cancer survival by 66% compared to similar cancer patients without blood clots. blood thinners may prevent clots but major bleeding is also a problem, so preventive therapies are not used routinely. identifying patients at highest risk for clots is critical. a tool exists but it has not been used outside of research. we propose to study how to apply this tool in clinical practice and test if it works.

patients with cancer have a risk for venous thromboembolism (vte) including deep-vein thrombosis (dvt) and/or pulmonary embolism (pe) that is markedly higher than non-cancer patients. an acute episode of vte has deleterious effects on the quality of life and long-term survival of cancer patients. cancer patients with vte have survival rates that are only one third of otherwise identical patients without vte. once vte is diagnosed over 10% of cancer patients suffer a further event while on standard therapy and over 5% suffer a major hemorrhagic event. the best way to treat vte is its prevention (thromboprophylaxis). studies suggest that among ambulatory cancer patients, risk for vte varies markedly between patients and that the lack of knowledge of this risk, delays diagnosis and hampers efforts to effectively prevent vte. therefore, the identification of patients at high-risk for vte may enable faster diagnosis of vte and better use of thromboprophylaxis. recent studies have developed a novel tool to stratify vte risk in cancer patients before they initiate anti-cancer treatment. we hypothesized that this risk tool will accurately identify cancer patients at high-risk and that its implementation in our clinical practice will result in a faster clinical diagnosis of vte. our objective is: a) to evaluate the ideal strategy to incorporate the tool in our clinical setting as seamlessly as possible, and b) to determine whether the tool accurately predicts risk and results in a faster investigation for vte. patient eligibility will be determined during the patient's initial consult to the ottawa cancer center after cancer diagnosis has been confirmed by the medical oncologist and before initiation of anticancer treatment. follow-up for this study will be for 12 months and patients will be seen at the time of scheduled appointments for cancer treatment.

Eligibility criteria:
inclusion criteria: * 18 years old or older * with a newly diagnosed cancer site (brain, bladder, lung, testicle, pancreas, stomach and lymphomas) * or progression of the malignant disease after complete or partial remission who have not recently received chemotherapy (≤ 3 months), radiotherapy and surgery (≤ 2 weeks) exclusion criteria: * cancer patients with confirmed vte or arterial embolism within the last 3 months * cancer patients who are receiving continuous anticoagulation

Keywords: venous thrombosis cancer coagulation factors blood